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wise, i believe i can feel the hemorrhoid but now that i think about it i suppose it could be neuropathic. i feel discomfort and a burning sensation. both of which are symptoms of neuropathic and hemorrhoids. when i apply cream i do feel relief however, which leads me to believe that it is, in fact, a hemorrhoid. i can't feel a pin or suppository but sometimes i can feel pressure. what do you think?

I am trying to get an opinion of a experienced practicing physiatrist to comment on the interpretation of the ASIA score. Let me frame the question a little more clearly. As I understand the classification, anybody who has anal sensation would not be classified an ASIA A. If the person does not have any motor function below the neurological level (this includes voluntary sphincter contraction) that person would be classified an ASIA B. If the person has any motor function below the neurological level, including voluntary sphincter contraction, the person would be classified an ASIA C. If the motor score exceeds 50% of the possible score below the neurological level, the person would be classified an ASIA D.

Therefore, based on the above, I believe the following statements to be true:

1. A person who has anal sensation and voluntary anal contraction would be classified an ASIA C or higher.

2. A person who has anal sensation and any motor score of muscles below the neurological level (defined as the lowest segment that has normal motor and sensory function) would be classified an ASIA C or higher.

3. A person who has substantial motor function below the neurological level but no anal sensation or voluntary contraction would be classified an ASIA A.

If you have time, could you give a detailed explanation of anal sensation? I met Tie Qian in Beijing and he mentioned something about "deep sensation." That was the first time I had heard of such a thing and was wondering if you could elaborate. Thanks.

Deep sensation, particularly in the bowel, anorectal region, and bladder, are not well understood. While we know that light touch sensation (usually tested with a cotton swab or just finger touch) is carried by the dorsal columns and pinprick sensation representing pain is carried by the spinothalamic tracts situated in the lateral column, the spinal tracts that carry deep sensation including pressure on the legs are not well understood. There is a likelihood that autonomic systems may play a role.

The phenomenon and question which spinal tracts carry visceral sensation is of particular interest because of recent findings suggest that orgasms may be carried by non-spinal pathways. We know, for example, that the vagus nerve (the tenth cranial nerve) goes to the heart, stomach, guts, bladder, and probably sexual organs. The recent findings by Barry Komisaruk that women and animals with "complete" cord transections are still able to show evidence of orgasmic sensations is thought-provoking.

Wise.

• Komisaruk BR and Sansone G (2003). Neural pathways mediating vaginal function: the vagus nerves and spinal cord oxytocin. Scand J Psychol 44:241-50. Summary: The initial observations, made in our laboratory with Knut Larsson, of the ability of vaginocervical stimulation (VCS) to block withdrawal responses to foot pinch in rats has led to findings of multiple behavioral, autonomic, and neuroendocrine effects of this potent stimulus in rats and also in women. It has led to an understanding of: (1) the neuroanatomical and neurochemical basis of a novel and potent pain-blocking mechanism; (2) likely neuroanatomical pathways mediating both the Ferguson reflex and a specific autonomic response - the pupil-dilating effect of VCS; (3) a role for oxytocin as a putative central nervous system neurotransmitter that stimulates autonomic sympathetic preganglionic neurons within the spinal cord; and (4) a novel pathway that can convey sensory activity from the cervix, adequate to induce orgasm, via the vagus nerves. This latter pathway bypasses the spinal cord and projects directly to the medulla oblongata, and thus can convey genital afferent activity despite complete spinal cord injury at any level. Department of Psychology and Biological Sciences, Rutgers, The State University of New Jersey, Newark, New Jersey 07102, USA. komisarb@nigms.nih.gov.

To my knowledge, the ASIA classification emphasizes pinprick and touch of S4/S5 (not deep rectal sensation) and voluntary sphincter contraction. At least this was what we had in mind when I was on the committee on ASIA classification back in 1990-1992. I don't think that they have expanded the definition of S4/5 sensation and motor function to include deep rectal sensation.

I was refer to this website by another member from the SCI forum and would like to seek your opinion of my dad injury.

My dad had an accident in August 2003. He had dislocate C6 & C7 (all ligament surrounding them torn), broken collar, fractured right hand and brachial plexus injury on the left hand.

My dad is now in a rehab centre trying his best to recover. He has pain due to his brachial plexus injury but still he is learning to walk everyday and is doing rather well now. Today, one of the nurse told me that although my dad has done a reconstruction of nerve ie nerve graft chances of his left hand recovery is slim. Do you have any advise for me on this?

At the same time, my other worry is that my dad seems to need some assistant (lactus) in passing bowel but according to my dad, he can control the discreting of bowel... not just flow out by itself. As for urine... the doctor tried taking out the catheter about 5 to 6 weeks ago... he can pass the urine by himself very well for one whole day but on the second day there was some urine retention so the doctor put the catheter on for him. My question is what is the chances of him recovering both his bowel and bladder.

The doctor told me that there is a kind of small like catheter for the patient to extract the urine by himself (caregiver also have to learn to help the patient) every 4 hourly but I was hoping that my dad would recover and have no need of such assistant.

So now I really need to know your professional opinion.

Anxiously waiting for your reply. For now, I just like to thank you in advance for whatever advise you can give me.